In July 2016, the American College of Physicians (ACP) conducted a review of randomized, controlled trials for insomnia treatment in English occurring from 2004 to September 2015, and arrived at the recommendation that Cognitive-Behavioral Therapy for Insomnia (CBT-I) should be the first choice of treatment for chronic insomnia. A second recommendation was for clinicians to use a shared-decision approach in discussing treatment options when CBT-I was not effective (Qaseem, A et al., 2016).
A recent randomized, control clinical trial conducted by Jack Edinger, Ph.D and Charles Morin, PhD. compared behavioral therapy and zolpidem (a medication used for sleep difficulties) for treating insomnia. What makes this research unique was that it provided follow-up treatment when a patient did not respond to the initial treatment method or as a supplement to the initial treatment method. The goal was to determine which treatment(s) would be the best first-choice for chronic insomnia and what to do if the first choice does not work.
Based on the preliminary results of the first 70 participants in the study, those who were administered behavioral treatment, half of the participants had some response, while one third of the group remitted. Those who did not remit were given zolpidem or cognitive therapy. With the administering of a second treatment, there was a cumulative response to the combined treatment and remission in another three-month follow up.
The participants in the group given Zolpidem first but did not remit were then given behavioral therapy or trazodone (another sleep medication). Remission and response rates after three months were lower in this group. These initial findings suggest behavioral therapy is more effective than zolpidem as a first approach to treating insomnia. This continues to confirm the recommendation set forth by the ACP, in that CBT-I should be the initial choice of treatment in this group.
References:
Qaseem, A., Kansagara, D., Forciea, M.A., Cooke, M., & Denberg, T.D. (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine. 165:125-133.
http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.pp8b4
